Elbow Impairments and Sx

MOI for UCL and common population

repetitive valgus stress. Common in throwiers

Main static stabilizer against valgus

flexor pronators eccentrically

main static stabilizer against valgus

UCL and medial capsule stabilize statically against valgus and ER.

Predisposing factors to UCL injury

past history of elbow injury, minimal rest and off time, pitching type and velocity, poor mechanics, long careers

Biomechanical factors of UCL injury

substantial force during late cocking early acceleration, over 50% valgus load goes through UCL

Questions for baseball subjective

what pitch type causes pain? Has there been a change in velocity or accuracy? Unexplained changes in stamina and strength?

What do if Ulnar Nerve symptoms are present

investigate because chronic UCL issue are associated with ulnar neuropathy

what percentage of pitchers will have pain during the acceleration and follow through phase respectively?

85% and 255

Phase 1 of Non-Op UCL treatment

2-3 month rest from pitching, daily icing and anti-inflammatories, splint/brace at night, ROM of flexors and pronators

Phase 2 of Non-Op UCL treatment

strengthening, and progressive return to throwing over 3 months, hyperextension brace if necessary

When is surgery indicated

failure of exhaustive non operative treatment, desire to return back to pre-injury performance, complete acute UCL rupture

What do we need to know for each graft type for UCL reconstruction

palmaris longus is ipsilateral but will have ROM restrictions, Semitendinosus and Gracilis will be contralateral to protect mechanics, big toe exrtensor

UCL Rehab Phase I

0-3 weeks, 4 weeks brace with restricted ROM, work on wrist ROM and elbow ROM in brace, gripping exercise, shoulder isos(noER) and bicep isos, ice to elbow and graft site

Landmarks at the end of UCL reconstruction Phase 1

light wrist flexion stretching, AROM of the shoulder, light scap work, bike for LE strength and endurance

UCL Rehab Phase II

4-7 weeks, d/c brace after 4 weeks, light PRE for UE, progressive shoulder program with emphasis on cuff and scap, thrower’s ten, AROM PNF, should have full ROM

UCL Rehab Early Phase III

8-14 weeks, eccentric elbow flexion and extension, forearm and wrist isotonics, thrower’s ten, resisted PNF, plyos, can golf, swim, and interval hit at week 12

UCL Rehab Phase III

14-32 weeks, strengthening, elbow and wrist strengthening and flexibility, maintain full elbow ROM, advance plyometrics, continue increasing UE strength, power and endurance, week 16 return tp throw program, gradual return to sport

complications of UCL repair

Ulnar neuropathy is most common, re-tear, inaccurate throw, lack of full extension, HO, medial epicondyle fracture, more operations decrease success rate

Risk of UCL repair

blood clots, DVT, nerve and vessel damage, infection, anesthesia complications

Ther Ex for LET: Moderate Evidence

Isometric, concentric, eccentric wrist extensor exercise for subacute or chronic.

resisted wrist extensor ex combine with manual for subacute or chronic

Ther Ex LET: weak evidence

shoulder and scap stabilizer muscle training when needed with other forms of resistance training

Ther Ex LET: Expert Opinion

phased approach introducing stress, increasing strengh endurance, and restoring motor control for people doing high demand activities

Manual Therapy for LET: Moderate Evidence

Local elbow joint mobs/manips to reduce pain, increase grip for short term outcomes

Manual Therapy for LET: Weak evidence

Joint mobs/manips directed at C or T spine and/or wrist

STM for pain in chronic 

IASTM with ex for chronic

Modalities for LET: Weak Evidence

Burst TENS high or low frequency with acupuncture

Cryo with TENS for people with symptoms over 30 days

Laser for pain and grip strength >4 weeks to 6 months

Other LET Treatments: Moderate Evidence

Rigid taping for pain and improved muscle fx for people with irritable symptoms

dry needling

Other LET treatments: Weak Evidence

KT tape, work place and ergonomic adjustments, behavioral changes

Other treatments for LET: Expert Opinion

Forearm counterforce or wrist support orthosis worn during activity for immediate pain relief and increased strenght

Other Treatments LET: Not recommended(weak)

no phonophoresis

Other Treatments for LET: No Recommend9conflciting)

deep transverse friction massage, ultrasound, forearm counterforce or wrist orthosis for intermediate or long term LET